Complete Rectal Prolapse

Indirect fixation of the rectum to the anterior ongitudinal ligament over the sacral promontory was performed at 146 operations for procidentia recti in a homogeneous series of 140 patients. Before fixation the rectum was widely dissected and thoroughly mobilized. The recurrence rate after follow‐up intervals of up to 15 years was 3.6 per cent. The procedure is simple to perform and eliminates the hazard of anastomotic breakdown which is associated with excisional methods. The authors regard it as the method of choice in the operative treatment of complete rectal prolapse.

mentioning

confidence: 99%

Complete prolapse of the rectum a report on 140 cases treated by rectopexy

Loygue

Huguier

Malafosse

et al. 1971

Abdominal rectopexy for rectal prolapse: a comparison of techniques

Duthie

Bartolo

1992

137

To compare the methods of abdominal rectopexy and to elucidate the mechanism by which rectopexy restores continence in patients with rectal prolapse, the role of sphincter recovery, rectal morphological changes and improved rectal sensation were assessed in 68 patients (eight men, 60 women) of median age 63 (range 18-83) years undergoing resection rectopexy (n = 29), anterior and posterior Marlex rectopexy (n = 20), posterior Ivalon rectopexy (n = 9) or suture rectopexy (n = 10). Preoperative and postoperative manometry, radiology and electrosensitivity measurements were made. Age and duration of follow-up were similar in all groups and the prolapse was controlled in all patients. Significantly improved continence was seen in all but the Ivalon group. There was no evidence of increasing postoperative constipation. Sphincter length and voluntary contraction were unaltered, but improved resting tone was seen in the resection and suture groups. This was not seen in the prosthetic groups. Improved continence correlated with recovery of resting pressure. Upper and sensation was improved in all groups. Radiological changes did not correlate with improved continence. We conclude that continence is improved by all rectopexy procedures but seems better without prosthetic material. Sphincter recovery seems to be the most important factor.

Rectoanal inhibition and incontinence in patients with rectal prolapse

Farouk

Duthie

MacGregor

et al. 1994

Thirty-five patients with complete rectal prolapse, 32 with neurogenic faecal incontinence and 33 controls underwent ambulatory recording using a computerized anal electromyographic and anorectal manometry system. Median resting anal pressures were 34 cmH2O in patients with prolapse, 51 cmH2O in those with neurogenic faecal incontinence and 94 cmH2O in controls. Median basal rectal pressures were 18, 21 and 21 cmH2O respectively. High-pressure rectal waves of median amplitude 71 cmH2O lasting 30-150 s and associated with inhibition of the electromyographic activity of the internal and sphincter and a fall in anal pressures were seen in all patients with prolapse but not in controls or those with neurogenic incontinence. These waves were abolished following successful resection rectopexy. Recovery of continence occurs by abolition of high-pressure rectal waves, which produce maximal inhibition of sphincter activity before operation.